What Oxy Clean really is - 3% Hydrogen peroxide

This was written by Becky Ransey of Indiana

“I would like to tell you of the benefits of that
plain little old bottle of 3% peroxide you can get for under
$1.00 at any drug store. My husband has been in the medical
field for over 36 years, and most doctors don’t tell you
about peroxide, or they would lose thousands of
dollars.”

1. Take one capful (the little white cap that comes with
the bottle) and hold in your mouth for 10 minutes daily,
then spit it out. (I do it when I bathe)

No more canker sores and your teeth will be whiter without
expensive pastes. Use it instead of mouthwash. (Small print
says mouth wash and gargle right on the bottle)

2. Let your toothbrushes soak in a cup of
“Peroxide” to keep them free of germs.

3. Clean your counters, table tops with peroxide to kill
germs and leave a fresh smell. Simply put a little on your
dishrag when you wipe, or spray it on the counters.

4. After rinsing off your wooden cutting board, pour
peroxide on it to kill salmonella and other bacteria.

5. I had fungus on my feet for years - until I sprayed a
50/50 mixture of peroxide and water on them (especially the
toes) every night and let dry.

6. Soak any infections or cuts in 3% peroxide for five to
ten minutes several times a day. My husband has seen
gangrene that would not heal with any medicine, but was
healed by soaking in peroxide.

7. Fill a spray bottle with a 50/50 mixture of peroxide and
water and keep it in every bathroom to disinfect without
harming your septic system like bleach or most other
disinfectants will.

8. Tilt your head back and spray into nostrils with your
50/50 mixture whenever you have a cold, or plugged sinuses.
It will bubble and help to kill the bacteria. Hold for a
few minutes then blow your nose into a tissue.

9. If you have a terrible toothache and cannot get to a
dentist right away, put a capful of 3% peroxide into your
mouth and hold it for ten minutes several times a day. The
pain will lessen greatly.

10. And of course, if you like a natural look to your hair,
spray the 50/50 solution on your wet hair after a shower and
comb it through. You will not have the peroxide burnt blonde
hair like the hair dye packages, but more natural highlights
if your hair is a light brown, reddish, or dirty blonde. It
also lightens gradually so it’s not a drastic change.

11. Put half a bottle of peroxide in your bath to help rid
boils, fungus, or other skin infections.

12. You can also add a cup of peroxide instead of bleach to
a load of whites in your laundry to whiten them. If there is
blood on clothing, pour directly on the soiled spot. Let it
sit for a minute, then rub it and rinse with cold water.
Repeat if necessary.

13. I use peroxide to clean my mirrors with, and there is
no smearing which is why I love it so much for this.

I could go on and on.  It is a little brown bottle no home
should be with out ! With prices of most necessities rising
, I ‘m glad there’s a way to save tons of money in
such a simple, healthy manner.

Menstrual cramps are a dreaded monthly enemy for every woman. Some women experience mild pain while some unfortunate ones have extreme pain to the point it interferes with daily life. Statistics show that approximately 50% of menstruating women have menstrual pain. 10% suffer extreme pain for a few days. If you are part of this 10%, then you are familiar with the excruciating pain felt in the pelvis, lower abdomen or back. These horrible menstrual cramps have become many women’s reason to skip work, classes or household chores. As they curl up in bed, the only thing on their mind is “how do I find relief from this menstrual pain?”

If you are tired of taking drugs, why not try Chinese herbal medicine? An international nonprofit organization called the Cochrane Collaboration did a review to compare the effectiveness of Chinese herbal medicine in relieving menstrual pain compared to western drugs. The outcome positively favored Chinese herbal medicine. Although they called for better studies in the future, I believe you can trust a medical system that has over 3000 years of history.

Below is a list of Chinese herbs that can help stop menstrual cramps:

1. Dong Quai (Chinese Angelica Root)
Also known as the “female ginseng,” it is commonly used to regulate the menstrual cycle and relieve menstrual cramps. It also helps to relieve menopausal symptoms, reduce PMS (pre-menstrual syndromes), improve anemic conditions and correct hormone imbalance. You can drink it as tea or cook it with chicken. Take note that the taste is strong and bitter.

2. Chuan Xiong (Szechwan Lovage Rhizome)
This herb is also a key medicinal herb when treating menstrual disorders. It improves blood circulation, promotes the flow of “qi” or vital energy and dispels wind to relieve pain. Other uses of this herb includes treating headache, heart disease, rheumatism, arthritis, carbuncles and boils. It has a pungent taste and a very strong aroma. Ancient Chinese women, dating back to the Song Dynasty, used to take this Chinese herb in the form of soup. The soup called Four Substance Decoction (Si Wu Tang) also included other Chinese herbs such as Chinese Angelica Root, Red Peony Root and Chinese Foxglove Root. They drank the soup as a tonic to relieve PMS, stop menstrual pain, strengthen the body and to look more beautiful.

3. Bai Shao (White Peony Root)
White Peony Root nourishes the blood and activates circulation. It is also used for a wide variety of gynecological problems such as vaginal discharges, threat of miscarriage, excessive menstrual bleeding, and menstrual cramps. White Peony Root can be found in a Japanese formula called toki-shakuyaku-san with five other herbs. The formula of Peony Root, Hoelen, Atractylodes Rhizome, Alisma Rhizome, Dong Quai and Chuan Xiong is said to be effective in reducing menstrual pain.

4. Yi Mu Cao (Chinese Motherwort)
Chinese Motherwort is a member of the mint family. The leaves of this herb is used to treat menstrual problems. It improves blood circulation and regulates the menstrual cycle. Herbalist also recommend it to treat anxiety and heart palpitations. The seed have also been found to benefit eyesight. Chinese Motherwort can be taken as a tea by infusing the dried herb with boiling water. If you find the taste too bitter and unpleasant, add honey or lemon to improve the flavor. this herb can also be found as a tincture. Do not use this herb during pregnancy or when bleeding is heavy.

5. Yan Hu Suo (Corydalis Rhizome)
There are two main functions of this Chinese herb: strengthen blood circulation and relieve pain. Corydalis is a relative of the opium poppy. Although only 1% in strength compared to opium, it is an effective relaxant and pain reliever. The alkaloids, specifically tetrahydropalmatine (THP) helps to relieve menstrual cramps It is usually combined with other herbs such as Pteropus and Bulrush (Shixiao San). Corydalis can be taken as a decoction, infusion, tincture or extract. You can look for it in Asian stores. Take note that this herb is not to be taken by pregnant or nursing women. Also be careful on the dosage. Some people have reported experiencing fatigue, nausea or vertigo after consuming large doses.

Except for Chinese Motherwort, Chinese herbal treatment usually combine several herbs together to address an individual’s needs. It is a unique formula for each person. Mixing these herbs together to produce an effective formula is an art. Therefore, consult with a licensed Chinese herbal medicine practitioner before taking the herbs.

Chinese herbal medicine can be a bit intimidating to westerners, what with funny sounding herb names and maybe having to face a Chinese practitioner that may know little english. However, it is beneficial to trust our oriental counterparts and their years of medicinal tradition. Give Chinese herbal medicine a try today and say goodbye to painful menstrual cramps.

By: Charlotte Stone

Abstract
Multi‑bed acupuncture clinics ‑ a recent and successful phenomenon in the UK ‑ utilise a new business model
for the provision of more affordable acupuncture treatments. Patients benefit from reduced cost of treatment
in exchange for some loss of privacy, and they overwhelmingly report being treated in a communal setting as
a positive experience. Practitioners benefit from a highly stimulating and supportive working environment, a
significantly increased potential client base and the satisfaction of providing more accessible treatment.

Acupuncture treatment in the UK has
predominantly been provided by a single
practitioner treating one patient at a time in
a private room, and usually staying with the patient
throughout the whole treatment, which might be
expected to last 45‑60 minutes in total. This is in
contrast to China, where cost‑ and patient‑ effective
treatment models have evolved over the centuries to
the current practice whereby patients usually receive
acupuncture treatment in large rooms containing
several beds. These effectively resemble the wards
found in conventional hospitals, although in this
case they are used for out‑patients. Thus one or more
doctors may treat several patients simultaneously.
Of all Complementary and Alternative Medicines
(CAM), acupuncture uniquely lends itself to this
style of practice, as needles usually have to be left
in the body for 10‑30 minutes. During this time, as
the patient rests, the doctor is free to treat another
patient.
The first well‑established clinic following a multi‑bed
model in the UK was the Gateway Clinic, London.
Founded by John Tindall in 1990, the clinic is funded
by the National Health Service’s (NHS) Lambeth,
Southwark and Lewisham Primary Care Trust (PCT),
and lies in the grounds of Lambeth Hospital. In 2004‑5
the clinic received £94,000 of funding and treated over
400 patients per week (Thomson, 2005), working out
at a fee of £4.52 per patient per treatment. All patients
must be referred by a general practitioner within the
local catchment area and can receive a maximum of
12 free treatments per referral. Patients with HIV and
Hepatitis C are given priority, can jump the waiting
list which is often several months, and can receive
unlimited treatments. Recently, due to constant
high demand and an ever‑expanding waiting
list, the clinic has had to restrict referrals to those
conditions clearly demonstrated by quality scientific
trials to be successfully treated by acupuncture,
i.e. musculo‑skeletal conditions, headache, cancer
treatment support, etc. In spite of this clinic’s perennial
cost‑effectiveness and popularity, its model has not
been replicated elsewhere in the NHS.
One of the first multi‑bed acupuncture clinics
independent of the NHS was the Dragon Acupuncture
Project in Brighton. It was founded in 2003 by Nik
Tilling and Calum Thomson out of a pragmatic need
to make a living in a town with a high number of
established practitioners, many new acupuncture
graduates, and a supportive but impecunious
population. It was inspired by the Gateway model, and
quickly became popular with the local community.
Other practitioners heard of the Dragon’s success,
or were themselves inspired by the Gateway, or
by clinics in the United States such as ‘Working
Class Acupuncture’ in Portland, Oregon, founded
by Lisa Rohleder, an eloquent and passionate
advocate for the integration of multi‑bed
acupuncture practice into American healthcare
(see www.workingclassacupuncture.org and www.
communityacupuncturenetwork.org). Since 2004,
13 new independent multi‑bed clinics have been
established in the UK, with more expected this year.

What is a multi‑bed acupuncture clinic?
I would like to propose a definition of multi‑bed
practice as one where a practitioner treats more than
one patient per hour in the same room, with the aim
of making acupuncture treatment more affordable.
Beyond that, it is clear that multi‑bed practice differs
widely from country to country and clinic to clinic:
“In the USA, an acupuncture treatment was more
commonly offered using recliner seats and point
prescriptions involving ’distal’ acupuncture points.
Charges were also often made on a sliding scale basis,
averaging $15‑35 per individual treatment. In the UK
a more traditional approach was taken to providing
low‑cost, multi‑bed treatments, where full‑body
acupuncture is more commonly used but on multiple
beds. Reduced rates are offered by treating more
than one person at a time, but usually on a fixed rate
averaging £15.” (Potter, 2008).

It is not exactly clear why the difference exists between
the two countries. I suggest that a ‘tradition’ has
rapidly emerged in each country, whereby the model
of practice in the first successful clinic has largely
been followed by subsequent clinics.
In the UK, multi‑bed clinic models vary widely.
The Gateway consists of a large room with nine beds,
some separated by screens. Another large room serves
as a waiting room, and a ‘drop‑in’ ear‑acupuncture
clinic. There is a small room where patients can talk
to their practitioner in private if necessary, although
this is rarely used. The clinic employs several salaried
practitioners and is popular for newly‑qualified
practitioners to intern. Each practitioner treats up to
three patients per hour.
Some independent clinics follow this model quite
closely, for example the Dragon Acupuncture Project
in Brighton, which also has up to nine beds, some
screened off. At the Dragon, as at many of the other
independent clinics, an additional private room is seen
as essential. It is always used to take the initial case
history, and is also available for any patient to discuss
issues that feel too personal to talk about within
earshot of other patients. The Dragon treats around
130 patients each week, employing three or four
practitioners, who treat up to three patients per hour.
Other clinics are run by just one or two practitioners,
who may treat between two and four patients each
hour. Practitioners may choose to split their practice
between multi‑bed and one‑to‑one practice; others
prefer just multi‑bed practice. Most clinics use an
appointment system, fewer operate a drop‑in system.
Some clinics have their own receptionist although this
is expensive; others may make use of the receptionist
provided by the clinic where they rent space, or use
an ‘invisible receptionist’ system1.
Some clinics have found success by working
alongside, and using rooms provided by, other
organisations, such as Age Concern (Four Gates,
Ealing, London). It would appear, in fact, that due
to financial realities, no independent clinic at the
time of writing enjoys full‑time use of its own space,
but instead rents spaces in other CAM clinics, yoga
studios, etc. This is not the case in the USA, where
rents are more reasonable.
Clinics may or may not provide auricular
acupuncture, facial acupuncture, Chinese herbs
or Chinese patent herbal remedies, tui na and
moxibustion, alongside traditional full‑body
acupuncture.
What are the advantages of multi‑bed practice
from the point of view of patients?
Obviously one of the main advantages for patients
is increased affordability of treatments: “With the
national minimum hourly wage currently at £5.52
(HMRC, 2008) and the national average hourly wage
equating to approximately £9.50 (Office for National
Statistics, 2007), a single acupuncture treatment
[in one‑to‑one practice] can represent more than a
day’s pay for many people. These figures suggest
that acupuncture is likely to be inaccessible to large
sections of the population.” (Potter, 2008).
Research at the Dragon showed that 90% of patients
were attracted to the clinic because of the cost of the
treatments, with 90% also reporting that the main
benefit of this was that they could afford to come as
regularly as they needed and perhaps afford to utilise
two therapies at the same time. In order to be effective
for certain complaints, acupuncture is best performed
intensively. However, in one‑to‑one practice in
the UK, a tradition (following the homeopathy/
psychotherapy treatment model and financial
constraints) has emerged of weekly treatment being
the norm. This is unrelated to practice in China and
may damage the prognosis for some conditions.
As Giovanni Maciocia points out, “You call weekly
treatment proper treatment for here, but that’s created
by social circumstances. We’re in private practice and
people can’t afford to come more often. If they could
they would come every other day” (Kaptchuk, 1985).
73% of patients at the Dragon Project reported that
they were either receiving social security payments,
or had chronic illness, and 59.6% of patients earned
less than £1500 per month, meaning they would not be
able to pay, or only pay infrequently, for the treatment
they needed at full (one‑to‑one) cost (Stone, 2006).
Another significant advantage for patients at the
Dragon was that the clinic filled their need for a sense
of community. The research showed that initially
patients were drawn because of the low cost, with
only 7.6% either aware of or actively supporting the
ethos of the clinic. However, after experiencing the
feel of the clinic for at least two treatments, 9.6% of
questionnaire respondents specifically mentioned
that they like the sense of community, 5.7% said
it reminded them they weren’t alone in having
problems, and 44.2% said they enjoyed the atmosphere
created when many patients were treated together.
11 out of 14 respondents who made extra comments concerning “unexpected positive aspects of being
treated at the Dragon” mentioned ‘community’. One
patient (male, aged 33) noted, “I think it is positive
to be seen in our conditions by others. It humanises
illness and distress and unifies us.” Another found
that, “It makes treatment less isolating, puts my
own treatment into perspective. Makes me feel less
precious and self‑involved” (male, 47). Some patients,
particularly those with long‑term illness, simply
appreciated the social aspect of the project and enjoy
the “friendliness of the clinic with people chatting
and enjoying each others’ company” (female, 70). We
notice, at the Dragon Project, that patients are now
as likely to recommend the clinic for its atmosphere
as for its low cost. This is borne out by the fact that
17.5% of patients are on salaries of £24,000 ‑ 36,000 per
annum, with 5.2% on more than £36,000, and could
therefore arguably afford more expensive treatments
(Stone, 2006).
Practitioners in several clinics have noticed that
patients seem to respond unusually well to treatment
in multi‑bed clinics. Tom Kennedy, of Four Gates,
Ealing, says, “I feel as though the dynamic created
by a shared healing environment definitely adds
something to the process. It doesn’t suit everyone, but
most people seem quite happy in this setting. There
is a ‘buzz’ at busy times which just isn’t present in
a private setting, and quite the opposite from being
distracting, I believe this invigorates most patients.”
There is also political/ideological appreciation
amongst patients of treatment being made available
to a wider section of the community. One patient
noted, “I like the idea of a cooperative venture that
aims to make acupuncture affordable to all – not
just middle class people with plenty of disposable
income” (female, 50). Another said, “There’s a kind of
collective feel about getting treatment in a room with
other people. And it is that sense of … that it’s a clinic
that’s dedicated to the welfare of a wider community,
in the same way that a doctor’s surgery is, you kind of
feel a part of something bigger.” (female, 39) (Stone,
2006).
40.3% of patients in the Dragon Project research
reported that they liked to be left alone during
treatment, rather than feeling obliged to chat with
their practitioner. They appreciated that in a multi‑bed
clinic, they were able to relax in peace, but of course
were not actually alone in the room and therefore felt
safe. One patient had experienced an abuse of dignity
when she was being treated in one‑to‑one practice in
the past; she felt safer and more comfortable being
treated in a room with several other people at all
times, “because the chances of these kinds of abuses
happening is so much reduced” (Stone, 2006).

Disadvantages from the point of view of patients
One of the most significant concerns for NHS patients
has been shown to be maintaining a reasonable level
of privacy/confidentiality during treatment (Douglas
and Douglas, 2003). Patients were shown to be more
likely to withhold information when talking to clinical
staff in curtained‑off areas in hospital than in areas
separated with solid walls (Barlas et al, 2001). This is
obviously relevant to multi‑bed acupuncture clinics;
the research from the Dragon Project clearly shows
that confidentiality is the single most common concern
that caused patients to report a ‘negative experience’,
with a smaller number of patients concerned about
removing their clothes or seeing others’ unclothed
bodies. Patients being treated for straightforward
physical complaints reported no problems with
confidentiality. As patients required more emotional
support or had to reveal very personal information,
the implications of being treated in close proximity
to other patients became more evident (Stone, 2006).
This shows that both patients and practitioners need
to be realistic about the limitations of confidentiality
in this type of clinic. How to deal with this –
provision of private spaces and screens and gowns, for
example – is up to each clinic. Anecdotally, patients at
the Dragon report that they feel able to comfortably
receive treatment for complex and emotional issues
because they know they can talk in private whenever
they feel the need. Patients should be made well
aware of the set‑up of the multi‑bed clinic before
they commence treatment, as this will constitute an
aspect of informed consent. It must also be noted that
staff sensitivity powerfully affects patients’ feelings
around privacy, both in the NHS (Bailey, 2005) and
in multi‑bed clinics. And, as mentioned above, once
comfortable in the multi‑bed setting, the pay‑off for
less privacy seems to be a sense of communion with
one’s fellow patients.
It is inevitable that there will be more noise in a
multi‑bed clinic than in a one‑to‑one clinic, and this
can disturb patients. Patients are less tolerant of
chatter that is not related to treatment, either from
staff or other patients, for example when friends
bump into each other or practitioners “talk shop”
(Stone, 2006). Patients tend to learn to modify their
behaviour, and again good boundaries and sensitivity
on the part of practitioners are required to make the
space effective.

Different clinics choose which treatment styles they will
utilise within the tighter time constraints of multi‑bed
practice. This may result in patients missing out on very
fine or time‑consuming treatment styles such as tui na,
moxa cones, etc. For example clinics in the USA generally
prefer to use distal rather than full body points, while
clinics in the UK are more likely to try to provide a very
similar treatment to one that a patient might expect from
a one‑to‑one treatment (Potter, 2008), but this may not
always be possible.
While most patients appear to enjoy the atmosphere
created in multi‑bed clinics, there will be some vulnerable
patients who are unable to feel safe or relaxed surrounded
by other people. Acupuncture can bring up intense
feeling states and practitioners need to be extra sensitive
to the needs of vulnerable patients. Patients in the Dragon
research reported feeling vulnerable when, for example,
they unexpectedly bumped into a work colleague they may
have struggled with or feared repercussions from; or when
another patient might inappropriately have commented on
personal issues they had overheard (Stone, 2006).
What are the advantages of multi‑bed clinics from
the point of view of practitioners?
The Dragon Project was set up to enable its practitioners to
earn a living where they were struggling to do so before,
and it has been successful in this by massively expanding
its potential client base. Patients with less disposable
income are now more able to access treatment. Also,
patients are able to afford treatment frequently enough
and for long enough to get better and stay better, and to
use acupuncture for ‘maintenance medicine’ once they
are better, meaning there is a high retention of long‑term
patients. It is also easier to publicise a clinic in the local
press that is offering something new or unique, rather
than being just another one‑to‑one practitioner in a busy
marketplace.
Multi‑bed practitioners will treat between two and
four patients each hour in the UK, and up to six in the
USA. High patient numbers allow for faster practitioner
development, as it may take many years to build up to such
numbers in a one‑to‑one practice. When one’s patients are
more relaxed about the financial demands on them, a more
satisfying and clinically successful treatment experience
may emerge for all. Nik Tilling, of the Dragon Project,
explains, “It’s important to recognise that acupuncture is
not just an intellectual process, which is one of the pitfalls
of the acupuncture courses currently available. In fact, the
actual act of acupuncture (needle insertion and engaging
with qi) isn’t intellectual at all; it’s all about developing
sensitivity to what is occurring in the present moment.
Speaking for myself, I wasn’t improving in that aspect of
my practice whilst I was struggling with limited numbers
of patients working one‑on‑one. Multi‑bed practice allows
you to relax into the clinical experience. The pressure to
give unrealistic prognoses due to the high cost of treatment
is eliminated.”
Practitioners in multi‑bed clinics enjoy the ethical
and ideological aspect of offering acupuncture to a
wider section of public. Stephen Potter, recent graduate
from Westminster University, says he chose to research
multi‑bed clinics, “because I am committed to social and
health provision for all, and could not work in a situation
that perpetuated the myth that acupuncture is only wanted
or needed by the upper middle classes. It is definitely an
ideological standpoint for me rather than an economically
convenient one; I am just so happy to feel part of a growing
movement.” Multi‑bed practice enables the provision of
cheaper treatment for those practitioners who do not wish
to work within the bureaucracy of the NHS.
There are constant opportunities for learning when
working in a team of practitioners. Every practitioner has
their own specialities and one may notice at any moment
a colleague using an unfamiliar point combination or
technique. It is straightforward to ask for a second opinion,
and one’s patient will know the other practitioner by sight.
This also eradicates the need to entrust one’s patients to an
unfamiliar locum, and we find at the Dragon for example,
that we have a high retention of patients when one of our
practitioners is away, whilst many of our ‘one‑to‑one’
colleagues complain of struggling with locum care.
Finally, just as patients are protected from abuses of
dignity because of the constant presence of witnesses,
so practitioners are protected from wild accusations of
malpractice for the same reason.

Disadvantages from the point of view of practitioners.
The only real disadvantage of multi‑bed practice is being
on one’s feet more than in private practice and having
to maintain the threads of several treatments at once. I
imagine this sort of practice will suit some people more
than others – it is more physically demanding, and I am
uncertain a practitioner could sustain this five days a week.
Practitioners at the Dragon work up to three days each
week, seeing between 50 and 60 patients (which is enough to
earn a living), and appreciate their rest days. However, the
physical demands are offset by working in an emotionally
supportive environment. Many practitioners complain of
isolation and loneliness in one‑to‑one practice, with only
their patients, who may be unwell, needy and draining,
for company. In multi‑bed clinics a practitioner talks less
and needles more, and it is becoming an unofficial talk
therapist that often seems to drain practitioners the most,
whereas needling is generally considered energising. It is
not only patients who feel the sense of ‘community’ that a
multi‑bed clinic provides, but the practitioners also form
a close team bond. Even those practitioners who run their

clinics alone report that treating several patients in the
room together generally prevents any individual patient
from draining their energy. To avoid burn‑out on a
daily basis, practitioners at the Dragon recommend
a long midday break with a satisfying lunch and a
siesta as essential.

Conclusion
There is and will remain a place, and a market, for
one‑to‑one acupuncture practice in the UK. However,
the various advantages of multi‑bed clinics mean
that patients are ever more likely to be treated in a
community setting. The largest drawback for patients
– lack of privacy – is countered by the destigmatising
effect of receiving treatment in a community
space. The largest drawback for practitioners – the
demanding pace – is countered by the support of a
team and the ability to earn a living by working three
days a week in a busy clinic. The multi‑bed business
model has shown itself to be successful, and I believe
that multi‑bed practice will form a significant part of
the future of acupuncture practice in the UK.
Charlotte Stone has been involved with the Dragon
Acupuncture Project in Brighton, UK since 2004, initially
as administrator, then as practitioner when she qualified
in 2006. She has practiced NADA auricular acupuncture
in a group setting since 2004 and is a certified instructor of
qigong. She coordinates Affordable Acupuncture UK, an
organisation which aims to promote and support multi‑bed
clinics in the UK.

Affordable Acupuncture
Affordable Acupuncture UK was founded in 2007 to
inform the public and practitioners about multi‑bed
practice and to support and encourage the emergence
of new multi‑bed clinics. The Affordable Acupuncture
UK website (www.affordableacupunctureuk.co.uk)
listed three new clinics just in the month of July,
2008. If you would like further information on
multi‑bed practice in the UK, or are interested in
setting up a clinic, please contact Charlotte on info@
affordableacupunctureuk.co.uk.

Bibliography
Bailey J, McVey L, Pevreal A. (2005) Surveying patients as a start
to quality improvement in the surgical suites holding area.
Journal of Nursing Care Quality; 20 (4): 319‑26.
Barlas D, Sama AE, Ward MF, Lesser ML. (2001) Comparison of
the auditory and visual privacy of emergency department
treatment areas with curtains versus those with solid walls.
Annals of Emergency Medicine. 2001; 38: 135– 139.
Douglas C, Douglas M. (2003) Patient‑friendly hospital
environments: exploring the patients’ perspective. Health
Expectations, 2004; 7: 61–73.
Kaptchuk, T et al. (1985) Acupuncture in the West – A discussion
between Ted Kaptchuk, Giovanni Maciocia, Felicity Moir
and Peter Deadman. Journal of Chinese Medicine. Jan 1985:
17; 22‑31
Potter, S. (2008). What is low‑cost, multi‑bed acupuncture? Available
at http://www.affordableacupunctureuk.co.uk/links.html
Rohleder, L. (2006). The Remedy: Integrating Acupuncture into
American Healthcare. May be purchased or downloaded from
http://www.lulu.com/content/466287
Stone, C. (2006) Investigating patients’ experiences of receiving
acupuncture treatment in a multi‑bed clinic: A case study of
the Dragon Acupuncture Project, Brighton. Available at http://
www.affordableacupunctureuk.co.uk/links.html
Thomson, A. (2005) A healthy partnership: Integrating
complementary healthcare into primary care. London. The
Prince of Wales’s Foundation for Integrated Health London,
England

Endnotes
The “invisible receptionist” system may vary in details from clinic
to clinic, but essentially frees up practitioner time by allowing
patients to book appointments themselves. A clinic will provide
a diary, with instructions, a pencil and appointment cards for
patients to fill in after each treatment. Patients may be coded
by numbers or initials to protect confidentiality. Inside the
treatment room, patients will be handed an envelope into which
they place their payment, posting it in to a payment box.

By Charles Shang, MD

Abstract:
Objectives:
The gold standard in testing scientific theory requires multiple independent prospective tests. This standard is applied to basic acupuncture research. This article reviews the key results of basic acupuncture research which meet the gold standards and discusses their implications.

Method:
Literature search and review of publications in medline and Chinese medical literature databases are combined with discussion with many experts to identify and analyze the models in basic acupuncture research which have predictions. These predictions are further checked for independent confirmation by multiple research groups.

Results:
Initial literature screen identified more than 400 related articles. Further analysis and discussion showed that the growth control model is the only published model in basic acupuncture research which has met the gold standard. It encompasses the neurophysiology model and suggests that a macroscopic growth control system originates from a network of organizers in embryogenesis. The activity of the growth control system is important in the formation, maintenance and regulation of all the physiological systems. Several phenomena of acupuncture such as the distribution of auricular acupuncture points, the long term effects of acupuncture and the effect of multimodal nonspecific stimulation at acupuncture points are consistent with the growth control model. The following predictions of the growth control model have been independently confirmed by research results in both acupuncture and conventional biomedical sciences: 1. Acupuncture has extensive growth control effects. 2. Singular point and separatrix exist in morphogenesis. 3. Organizers have high electric conductance, high current density and high density of gap junctions. 4. A high density of gap junctions is distributed as separatrices or boundaries at body surface after early embryogenesis. 5. Many acupuncture points are located at transition points or boundaries between different body domains or muscles, coinciding with the connective tissue planes. 6. Some morphogens and organizers continue to function after embryogenesis.

Conclusion: Current acupuncture research suggests a convergence of the neurophysiology model, the connective tissue model and the growth control model. The growth control model of acupuncture set the first example of a biological model in integrative medicine with significant prediction power across multiple disciplines. Basic acupuncture research has met the gold standard of science with multiple independently confirmed predictions.

Introduction

According to the World Health Organization (WHO), a broad definition of acupuncture is the stimulation of certain points on the body (acupuncture points) using needling, moxibustion, electricity, laser, or acupressure for therapeutic purposes.¹ The Standard Acupuncture Nomenclature published by the WHO listed about 400 acupuncture points and 20 meridians connecting most of the points.² Results from randomized controlled trials (RCTs) have shown that acupuncture is effective in treating dozens of disorders¹ such as osteoarthritis ^{3, 4, 5} pelvic and back pain ⁶ neck pain ⁷ migraine and tension headache ^8,9 nausea/vomiting ¹⁰ and inflammatory bowel disease.¹¹ Mixed results widely exist in acupuncture research¹² for various reasons. Many neurohumoral ^{13, 14, 15, 16} mechanical and growth control effects of acupuncture¹⁸ have been observed. Several models of acupuncture mechanism have been proposed. The focus of this article is on the biological models of acupuncture which can meet the gold standard of science with multiple independently confirmed predictions.

The Observations from Acupuncture Research

In the mid-70s, the discovery of endorphin induction in acupuncture analgesia and its blockade by naloxone was instrumental in establishing the validity of acupuncture in modern science.^{19, 20} In acupuncture analgesia, the peripheral nervous system has been shown to be crucial in mediating the effect. The analgesia can be abolished if the acupuncture site is affected by postherpetic neuralgia²¹ or injection of local anesthetics.²² Different frequencies of electric stimulation in electroacupuncture lead to release of different neuropeptides.¹³ Electroacupuncture has been shown to release nociceptin and inhibit the reflex-induced increases in blood pressure¹⁶ and increased the synthesis of nitric oxide in mediating the protective effect on gastric mucosa.²³

Since the 1950s, it has been discovered and confirmed with refined techniques¹⁴ that many acupuncture points and meridians have high electrical conductance^{24, 25, 26} though the results are sometimes mixed.²⁷ High electric conductance of acupuncture points have been successfully used for locating acupuncture points in acupuncture therapy.²⁸ The high electric conductance at acupuncture points is further supported by preliminary finding of high density of gap junctions at the epithelia of the acupuncture points.^{29, 30, 31, 32} Gap junctions are hexagonal protein complexes that form channels between adjacent cells. It is well established in cell biology that gap junctions facilitate intercellular communication and increase electric conductance. High concentrations of nitric oxide and nitric oxide synthase have also been observed at acupuncture points and meridians.³³

Modern Biological Models of Acupuncture

In the 1970’s, the relation between the nervous system and acupuncture alteration of visceral function was explored by examining the cortical evoked potentials, single unit discharges and neurochemistry associated with acupuncture. These studies brought forth the Meridian-Cortex-Viscera correlation hypothesis which states that: 1. The meridian system is an independent system connected via the nervous system to the cerebral cortex. 2. It acts through neurohumoral mechanisms.³⁴ A contending model claimed that the meridian system as described in the classic acupuncture literature does not exist and that all the effects of acupuncture are mediated through nervous system.^{35, 36}

Another hypothesis suggested that the network of acupuncture points and meridians is a signal transduction network formed by interstitial connective tissue. Mapping of acupuncture points on human arm showed an 80% correspondence between the sites of acupuncture points and the location of intermuscular or intramuscular connective tissue planes in postmortem tissue sections.³⁷

Modern biological models of acupuncture are confronted with the following puzzling facts:

1. The distribution of acupuncture points: The distribution of acupuncture points is different from the distribution of nerves, blood vessels, lymphatics or connective tissue. For example, an auricle has no important nerves or blood vessels or lymphatics or complex connective tissue planes and no significant physiological function other than sound collection. While the vagus nerve has an auricular branch, this branch has no known important function in modern neuroscience. A search of Medline did not yield any article on the function of the auricular branch of vagus nerve in the past 50 years. The auricle nevertheless has the highest density of acupuncture points. According to the WHO, 43 auricular points have proven therapeutic value,² which consist of more than 10% of the acupuncture points of the entire human body. Numerous RCTs have demonstrated the efficacy of auricular acupuncture^{38, 39, 40, 41, 42, 43} while some results are mixed.¹²
   
2. The non-specific activation of acupuncture points: Therapeutic effect of acupuncture has been achieved by a variety of stimuli^10,1 including needling, injection of nonspecific chemicals, electricity, temperature variation, laser, and pressure. No conventional nerve stimulation technique has such diverse modalities of stimulation. Non-noxious stimuli such as non-thermal low intensity laser irradiation, which does not cause local nerve excitation⁴⁴ or collagen fiber reorganization at acupuncture points, can cause extensive systemic effects⁴⁵ and stimulate local cellular calcium oscillation,⁴⁵ cell proliferation, release of basic fibroblast growth factor, interleukins as well as other growth control effects.⁴⁶ This suggests that another system other than nervous system mediates the initial signal transduction in acupuncture.
   
3. Transient acupuncture stimulation often causes long lasting effect over weeks or months. For example, two RCTs^9,8 have shown that the relief of migraine headache lasted 1 year after acupuncture treatment – thousands of times longer than the physiological half life of endorphin⁴⁷ and other common neurotransmitters. Similar long-term benefits of acupuncture have been shown by RCTs on the treatment of shoulder pain,⁴⁸ chronic low back pain,^{49, 50} primary dysmenorrhea,⁵¹ spinal cord injuries,⁴² urinary urgency⁴¹ and osteoarthritis.^{5, 52, 53} This long lasting effect is almost non-existent in conventional therapy using transient mild peripheral nerve stimulation. In conventional nerve stimulation, long lasting effects require long term stimulation as observed in the effects of opioids, serotonin reuptake inhibitors, sacral nerve stimulation,⁵⁴ and vagal nerve stimulation.⁵⁵
   
4. The existence of acupuncture points. i.e. why do stimuli at many acupuncture points cause diverse systemic effects without obvious benefit of survival for normal animals? For example, stimulation at acupuncture points PC6 and ST36 which are at the extremities increases the gastric motility in dogs.⁵⁶ This is contrary to the fight or flight response and seems to offer no survival benefit to animals. What is the intrinsic function of acupuncture points? How did these acupuncture points come into existence over the course of evolution?

In science, models or hypotheses capable of successful prospective predictions are considered more convincing than models solely based on retrospective explanations or accommodations.^{57, 58} The gold standard in testing a scientific theory is multiple independent confirmations of its predictions. It is therefore important to assess which theory in basic acupuncture research has met this gold standard. A literature research in PubMed with full text (Medline) using keywords acupuncture AND (predict* OR corollary) identified 101 articles. Similar search strategy in Chinese medical/scientific literature databases including http://www.wanfangdata.com.cn/, http://engine.cqvip.com/，and http://www.chinainfobank.com/ identified over 300 articles. Further review of the literature and discussion with more than a dozen experts in this field narrowed down to two biological models^59,18 which have independently confirmed prediction(s): The neurophysiology model on the long term effects of acupuncture⁵⁹ suggests: 1. The trophic and anti-inflammatory effects of acupuncture are important in mediating its long term effects. 2. Long term potentiation and long term depression are likely involved in acupuncture signal transduction. Its corollary on the peripheral anti-inflammatory effect of endorphin in acupuncture has been confirmed.⁶⁰ The growth control model first published in the 1980s⁶¹ correctly predicted multiple research results not only in acupuncture, but also in conventional biomedical sciences. It also has shed light on the puzzling observations mentioned above.^62,18 This model encompasses the neurophysiology of acupuncture¹⁸ and is supported by the research results on connective tissue at acupuncture points.^17,37 It is the only published model which has met the gold standard of the multiple independent prospective tests.

The Origin and Function of Acupuncture Points

It is well known that all the physiological systems, including nervous system, are derived from a system of embryogenesis - a growth control system.⁶³[Figure 1] In growth control, the fate of a larger region is frequently controlled by a small group of cells, which is termed an organizing center or organizer.⁶⁴ A gradient of messenger molecules called morphogens forms around organizers. Organizers have highest (sources) or lowest (sinks) local concentration of morphogens^{64, 65} and therefore are macroscopic singular points of morphogen gradient field. A singular point is a point of discontinuity. It indicates abrupt transition from one state to another. Small, nonspecific perturbations around singular points - organizers can have important systemic effect.^{66, 67} Several lines of evidence suggests that the bioelectric field interacts with morphogens and growth factors, and guides morphogenesis.^{68, 69} The growth and migration of a variety of cells are sensitive to electric fields of physiological strength.^{70, 71} Organizers and acupuncture points share several common features: Both commonly distribute at the extreme points of surface curvature^18,61,62 and are activated by non-specific stimuli.^67,61 Both are associated with bioelectric field.¹⁸ The growth control model therefore suggested that acupuncture points originate from organizers.^18,61

Confirmed Predictions on Organizers and Morphogens

Based on the connection between acupuncture points and organizers, the growth control model predicted that organizers have high electric conductance, high electric current density and high density of gap junctions.^18,61 These predictions on organizers have been independently confirmed: Organizers such as blastopore and zone of polarizing activity have high electric conductance, high current density⁷² and high density of gap junctions.^{73, 74, 75, 76} Multi-cellular organisms maintain regular form and function despite constant replacement of cells, intra-cellular components and extracellular matrix. Without growth control, this constant regeneration is prone to structural disintegration and degeneration into various tumors. The growth control model predicted that organizers and morphogens partially retain their regulatory function after embryogenesis.^18,61 This prediction has also been independently confirmed: Morphogens such as retinoic acid, Wnt, bone morphogenetic protein and Hedgehog as well as some organizers continue to exist and function in adult after embryogenesis.^{77, 78, 79, 80, 81}

Confirmed Predictions on Acupuncture

One corollary from the growth control model is that acupuncture has extensive growth control effects which have been confirmed: Acupuncture has been shown to regulate various growth factors and growth control genes. It can induce vascular endothelial growth factor⁸² and basic fibroblast growth factor⁸³ during brain ischemia. It also induces glial cell line-derived neurotrophic factor⁸⁴ and expression of the c-fos proto-oncogene.^{85, 86} Acupuncture regulates the expression of Bcl-2,⁸⁷ Bax, fas and FasL proteins which are involved in apoptosis signaling. Acupuncture inhibits the apoptosis of intestinal epithelial cells in inflammatory bowel disease of rats⁸⁸ and enhances proliferation of CD8+ lymphocytes,⁸⁹ reduces nerve growth factor in polycystic ovaries,^{90, 91}reduces IL-6 expression and proliferation of osteoclasts.⁹² The neuro-humoral factors induced by acupuncture such as endorphins, nitric oxide and serotonin also have growth-control effects.^{92, 98, 94} In RCTs, acupuncture has shown efficacy in treating growth control related disorders including spinal cord injuries³⁸ and low sperm quality.^{95, 96}

Growth Control System as Foundation of Pathophysiology

A growth control system originates from a network of organizers.⁹⁷ In embryogenesis, the development of organizers precedes the development of other physiological systems.^18,64 The formation, maintenance and regulation of all the physiological systems are dependent on the activity of the growth control system. Growth control is a primary function of all multi-cellular organisms. The evolutionary origin of the growth control system likely preceded all the other physiological systems. Its genetic blueprint served as a template from which the newer systems evolved. Consequently, it overlaps and interacts with other systems but is not merely part of the nervous system, immune system or circulatory system. The growth control signal transduction is embedded in the activity of the function-based physiological systems: The regulation of many neural, circulatory, immune processes and related disorders are mediated through growth control mechanisms such as hypertrophy, hyperplasia, atrophy, apoptosis with shared messenger molecules including morphogens^{98, 99, 77,81} and common signal transduction pathways involving growth control genes such as proto-oncogenes.^{100, 101, 102}

The Nonspecific Stimulation and the Long Term Effects of Acupuncture

Based on the growth control model, acupuncture points and organizers are singular points and therefore prone to nonspecific perturbation. The long lasting systemic effects of acupuncture can be achieved by nonspecific stimuli as mentioned above. Similarly, long lasting growth control activities of organizers have been induced by various stimuli such as mechanical injury and injection of nonspecific chemicals.⁶⁷ Based on the growth control model, acupuncture effect is a byproduct of the growth control network. Stimulating organizers – acupuncture points can not only cause transient modulation of neurotransmission, but also alter the growth control signal transduction in various systems - leading to long term effects.¹⁸

The Distribution of Acupuncture Points and Organizers

Organizers are at the extreme points of curvature on the body surface such as the locally most convex points (e.g., apical ectodermal ridge and other growth tips) or concave or saddle points (e.g., zone of polarizing activity).^{103, 18} Similarly, almost all the extreme points of the body surface curvature are acupuncture points. For example, the convex points include EX-UE11 Shixuan (finger tips), EX-LE12 Qiduan (toe tips), ST17 Ruzhong (tip of nipple), ST42 Chongyang, (the convex, palpable point of arteria dorsalis pedis), GV25 Suliao (nose tip) … The concave points include TE3 Zhongzhu (the concave point between the 4th and 5th metacarpal), KI1 Yongquan (at the concave point of the sole), GB20 Fengchi (the concave point below occipital bone, between upper ends of sternocleidomastoid and trapezius), BL40 Weizhong (midpoint of the transverse crease of the popliteal fossa), HT1 Jiquan (the most concave point of axilla), BL1 Jingming (at the concave point above medial canthus), CV8 Shenque (navel)… Based on growth control model, the extreme points of surface curvature are associated with organizers – acupuncture points. The auricle obviously has the most convoluted surface morphology of the human body. Therefore it has the highest density of extreme points of surface curvature and is expected to have the highest density of organizers - acupuncture points. Auricle exemplifies the interconnection of growth control: Auricular morphology is a sentinel of malformation in other organs. Auricular malformation has been observed in numerous malformation syndromes. It is recommended in a standard textbook of pediatrics that any auricular anomaly should initiate a search for malformations in other parts of the body.¹⁰⁴

The Origin of Meridians

The growth control model suggests that the discontinuity or abrupt transition in growth control not only exists at organizers but also along boundaries.^18,61 The growth control boundaries or folds between different structures are also called separatrices in mathematics and often connect singular points - organizers. The model predicted that growth control boundaries have high electric conductance and high density of gap junctions – just as the meridians in acupuncture which likely originate from growth control boundaries. These predictions have been confirmed: As embryogenesis progresses, high density gap junctions become restricted at discrete boundaries, leading to the subdivision of the embryo into communication compartment domains.^{105, 106} Increasing or decreasing the gap junctions can cause various developmental defects¹⁰⁷ such as spina bifida.¹⁰⁸ These high electric conductance boundaries are likely major pathways of bioelectric currents. Organizers are known to locate at boundaries between different structures.¹⁰⁹ The growth control model suggests that meridians originate from separatrices – boundaries in growth control and form an undifferentiated,^18,61 interconnected cellular network that regulates growth and physiology. In consistence with the prediction of under-differentiation of the meridian system and growth control system, it has been observed that the most apical part of folds of embryo remain undifferentiated in morphogenesis,¹¹⁰ including organizers such as apical ectodermal ridge.¹¹¹ As predicted by the growth control model, singular point and separatrix have important roles in morphogenesis.^{112, 113} Growth control boundaries/separatrices are similar to organizers in controlling growth and pattern formation with morphogen gradient.¹¹⁴ Many acupuncture points are located at boundaries between different body domains or muscles, coinciding with the connective tissue planes which connect adjacent body domains or muscles.^{17, 37, 115}

Summary

Current acupuncture research suggests a convergence of the neurophysiology model, the connective tissue model and the growth control model. The growth control model of acupuncture set the first example of a biological model in integrative medicine with significant prediction power across multiple disciplines. It is the first theory in basic acupuncture research which has met the gold standard in testing scientific theory. The following predictions of the growth control model have been independently confirmed by research results in both acupuncture and conventional biomedical sciences: 1. Acupuncture has extensive growth control effects. 2. Singular point and separatrix have important roles in morphogenesis. 3. Organizers have high electric conductance, high current density and high density of gap junctions. 4. A high density of gap junctions is distributed as separatrices or boundaries at body surface after early embryogenesis. 5. Many acupuncture points are located at transition points or boundaries between different body domains or muscles, coinciding with the connective tissue planes. 6. Some morphogens and organizers continue to function after embryogenesis. The growth control model has also shed light on several puzzling phenomena of acupuncture such as the distribution of auricular acupuncture points, the long term effects of acupuncture and the effect of multimodal nonspecific stimulation at acupuncture points.

Future Directions

1. The structure and cell differentiation at acupuncture points as well as the neurophysiology and growth control signal transduction involved in different modalities of acupuncture should be further delineated.
   
2. Manipulating the singular points - organizers of the growth control system may be a convenient way of activating intrinsic stem cells as evident from the improvement of sperm quality after acupuncture.^{95, 96}
   
3. As the growth control model predicts the growth control activity at acupuncture points/extreme points of surface (or interface) curvature after embryogenesis, residual morphogen gradient may still exist at these points and may be detectable by probing morphogen candidates such as Hedgehog, Wnt and TGF-beta families. Certain morphogen gradient distributes along boundaries.¹¹⁶ This pattern may persist after embryogenesis into adulthood and coincides with meridians.
   
4. Mapping of the growth control system and the dynamics of its electromagnetic field with high resolution techniques such as the superconducting quantum interference device (SQUID) and atomic magnetometer :¹¹⁷ The growth control model predicts that the singular points and separatrices of the bioelectric field in growth control correlate with the acupuncture points and meridians respectively.
   
5. The growth control model suggests that techniques involving the stimulation of the growth control system such as acupuncture can activate the growth control activity of an organism and improve its structure and function at a more fundamental level than symptomatic relief.¹⁸ In growth control, the change in electric field precedes morphologic change and manipulation of the electric field can affect the change.^{70, 118} Development of the techniques of detecting and manipulating the electric field may enable the diagnosis and treatment of a pathologic process at the early signal transduction stage prior to the anatomical or morphological change.
   
6. The growth control model suggests that apparently unrelated acupuncture points are not exactly ‘placebo’ points. The more acupuncture points are used as placebo points in a RCT, the more likely that some systemic effects will be resulted from the ‘placebo’ treatment. The self-regulatory effect of acupuncture will be difficult to predict when the patients have multiple comorbidities and many acupuncture points are used. Subtle, ‘sham’ stimulation at acupuncture points can be effective due to the response of the acupuncture points to nonspecific stimuli. These reasons may contribute to the mixed results in RCTs on acupuncture. This model also suggests that acupuncture is mostly likely to demonstrate its efficacy and advantage in a patient population with few comorbidities, relatively good general health and vitality and a regimen with efficient use of acupoints.
   
7. The growth control model suggests that the distribution of growth control system is related to both internal and external structures. Acupuncture points which are not at obvious extreme points of surface curvature or meridians which are not at obvious surface boundaries may be vestigial or related to interface between internal structures such as muscles and bones. Intrinsic stem cells are likely part of the undifferentiated growth control network. The germ cell is one of the least differentiated cells and also a type of stem cell – similar to the embryonic stem cell in its ability to differentiate into all three germ layers. The distribution pattern of intrinsic germ cells can be deduced based on the fact that the distribution pattern of primary tumors reflects the distribution of their normal counterpart. The primary germ cell tumors¹¹⁹ have a midline and para-axial distribution pattern which spans from the sacrococcygeal region to pineal gland. It appears to concentrate at 7 locations: sacrococcygeal region, gonads, retroperitoneum, thymus, thyroid,¹²⁰ suprasellar region, and pineal gland. This pattern reflects the distribution pattern of intrinsic germ cells which are likely to be highly inter-connected in a normal state (e.g. via gap junctions¹²¹ ) and provide important regulatory functions.^{122, 56} This also suggests a hierarchy in the degree of cell differentiation and function in the growth control system.

Acknowledgments

I thank Steven K.H. Aung, Zang-Hee Cho, Yuenan Cui, Li Dingzhong, Maria do Desterro Leiros, Michael Levin, Vitaly Napadow, Richard Nuccitelli, Stig Ollmar, Rosa N. Schnyer, San Wan, Peter Wayne, Raimond Wong, Seung-Schik Yoo for their input.

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Charles Shang, MD
Department of Medicine
New England Baptist Hospital
Harvard Medical School
125 Parker Hill Ave.
Boston, MA 02120
Tel: 617-754-5248
Email: cshang@caregroup.harvard.edu

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

BACKGROUND

There are at least three different types of ovarian cysts: the most common is the fluid-filled cyst that occurs at the site of the egg-producing follicle; alternatively, a cyst may appear in the corpus luteum, as a yellow mass of tissue; in rare cases, a cyst may be a malignant tumor of the ovary (cystadenoma or other type). Simple non-malignant ovarian cysts are usually asymptomatic and benign. In many cases, they spontaneously disappear. They have become a medical issue in the U.S. largely because of the recommendation that women obtain frequent pelvic examinations which then reveal the otherwise asymptomatic cysts, and because of the high frequency of delayed pregnancy which often gives rise to low fertility: ovarian cysts may be one of the suspected causes of the lowered fertility. In some cases, especially if the cysts are large, they may cause symptoms such as abdominal aching, pain during intercourse, menstrual irregularities, or painful periods. Hemorrhage into a cyst is a common cause of painful incidents involving the cysts. If a cyst is elongated and then twists, it can cause severe pain that may bring about the need for immediate surgery. About 5% of cysts may become cancerous. Yet another ovarian disorder, polycystic ovary syndrome, is mentioned following the discussion of treatments for non-malignant cysts.

TREATMENT OF SIMPLE OVARIAN CYST IN CHINA

In China, simple ovarian cyst is not considered a major medical problem. It is not mentioned in the English-Chinese Encyclopedia of Practical Traditional Chinese Medicine volume on gynecology; nor is it a significant subject in the extensive abstract journal, Abstracts of Chinese Medicine, which has been published since 1986; nor in the English language Journal of Traditional Chinese Medicine, published since 1981. Treatments for ovarian cysts with Chinese medicine are considered a relatively easy matter if cysts are diagnosed in the first place. The herbal formulas are reported to be effective with short-term administration. Ovarian cysts are probably most-often treated secondarily and without separate diagnosis, as part of a syndrome of infertility, since some of the formulas used for infertility, such as Tang-kuei and Peony Formula (Danggui Shaoyao San) and Cinnamon and Hoelen Formula (Guizhi Fuling Tang) are reported to resolve ovarian cysts.

From the Chinese medical perspective, a localized accumulation of fluid or a growth of soft (fatty) tissue, as occurs with ovarian cysts, is a type of phlegm accumulation disorder. The Chinese medical concept of phlegm (”tan“) crops up repeatedly. It is important in considerations of lung and sinus congestion, it shows up as one of the possible syndromes in cases of arthritis and autonomic nerve disorders, and it is a dominant concern in relation to obesity, in soft swellings of the lymph nodes, skin, and thyroid, and in atherosclerosis. Ovarian cysts fit into the broad category of phlegm disorders and differ from some of the other phlegm disorders that involve swellings, such as those of the lymph nodes, skin, and thyroid, primarily by location-deep in the lower abdomen.

According to the traditional view, the main reason for accumulation of fluids, including phlegm, in the lower body is failure of the kidney to “steam” the water upward. That function is part of the kidney yang. The physiological process that is visualized is that the kidney yang is like a heater, and as the water drains down to it from above, a portion of the water is steamed upward. The other portion drains downward to moisten the lower abdomen and legs, with a portion going to fill the bladder. The water that is steamed upward reaches the top of the body and then condenses, just as water vapor arising from the moist ground heated by the sun condenses after rising to form clouds and rain. This rainy mist moistens the sinuses, eyes, mouth, lungs, heart, and all other parts of the upper body. The lungs, which lay on top of the other organs, help disperse the water downward, moistening the dense internal organs and eventually returning the fluid to the kidney for recirculation.

The water-steaming aspect of the kidney is most often supported by the administration of cinnamon, especially cinnamon bark (rougui), incorporated into herbal formulas. This ingredient is often combined with hoelen (fuling), a moisture-regulating herb, in several important prescriptions for lower abdominal disorders, including Rehmannia Eight Formula (Ba Wei Di Huang Wan) and Cinnamon and Hoelen Formula.

When the water fails to steam upward, its main route of departure is through the bladder and there may be symptoms of frequent urination of clear liquid, which is typically treated with the Rehmannia Eight Formula. However, should the kidney not pass the water on to the bladder, then the water remains in the lower body. It may appear in the form of water accumulation, usually in the legs (with edema around the ankles and knees a common manifestation). The stagnated water can be transformed into phlegm, in which case the fluid takes on the character of a firm mass, such as an ovarian cyst. Abdominal fluid accumulation, including ovarian cyst, has been treated successfully with Cinnamon and Hoelen Formula, a prescription which also vitalizes the abdominal blood circulation.

A soft mass, regardless of its location, comes about from congealing of the otherwise fluid and mobile water. The congealing may result from heat (drying the fluid), cold (congealing the fluid), or pollution of the water (thickening with filth). The ovarian cyst that results from the most common mechanism-cold water congealing and accumulating-is treated by three therapeutic methods: warming up the kidney so as to prevent further accumulation, resolving the phlegm mass that already exists, and restoring normal blood circulation to the area that was affected by the cyst and by the coldness (so as to speed resolution and help prevent recurrence of the accumulation).

In China, simple ovarian cysts are most often treated with herbal combinations addressing these therapeutic requirements, though some prescriptions may focus on only two of the three concerns. The herbal treatments are reported to be very effective with a relatively short period of administration-about thirty days-though few details are given in the rare commentaries about this subject. Many of the treatments are based on the traditional prescription Cinnamon and Rehmannia Combination (Yang He Tang; literally, the yang heartening decoction). The term yanghe comes from an ancient classic where it is used to describe the first rays of spring sun thawing the congealed yin of winter.

Cinnamon and Rehmannia Combination was first described in 1740 (during the Qing Dynasty) in the book Wai Ke Quan Sheng Ji. It is a derivative of the traditional pill and decoction for “restoring the right kidney” (You Gui Wan and You Gui Yin) described many centuries earlier. According to the ancient medical ideas, the right kidney has the dominant function of supporting the yang, while the left kidney has the dominant function of supporting the yin. Cinnamon bark and cooked rehmannia, a pair relied upon for harmonious warming of the kidney, are ingredients found in You Gui Wan, You Gui Yin, Ba Wei Di Huang Wan, and Yang He Tang. Cinnamon is hot, spicy, and invigorating; rehmannia is warm, sweet, and calming.

Yin swellings (yin ju), the congealed fluid resulting from yang deficiency, most often appear just below the skin and are not clearly delineated. They differ from other types of accumulation in that they are not hard, nor are they red, hot, or erupting; they may be slightly painful, but this will be due to pressure from the fluid build-up, not sharp pain from blood stasis or from the action of intense heat-toxin. During treatment, the fluid is not forced outward: this is in contrast to treatments for yang swellings that lead to formation and then elimination of pus as the swelling is resolved, as occurs in therapy for breast cancer lumps. Rather, the congealed fluid is softened and set in motion, to be eliminated by the same means as normal fluids. Cinnamon and Rehmannia Combination is used to treat yin swellings such as lipomas, lymphatic swellings, and bone cysts (the latter two often the result of tuberculosis in the Chinese population). Typically, the patient who requires this type of therapy will reveal a pulse that is soft, sunken, and slow, and the tongue will appear pale with a moist, white coat.

The traditional Cinnamon and Rehmannia Combination has the following ingredients:

rehmannia	(shoudihuang)	30 grams
antler gelatin	(lujiaojiao)	9 grams
cinnamon bark	(rougui)	3 grams
roasted ginger	(paojiang)	2 grams
sinapis	(baijiezi)	6 grams
ma-huang	(mahuang)	2 grams
licorice	(gancao)	3 grams

In this formula, ma-huang is selected because of its warming action on the superficial skin layers, where it opens the pores and resolves stagnated circulation. Sinapis is selected to warm the lower layers of the skin and remove phlegm obstruction of the channels. Roasted ginger warms the muscles and cinnamon bark warms the interior, including the bones and marrow. Thus, every layer of the body is warmed. Sinapis, the spicy mustard seed, is described as having the ability to eliminate phlegm, disperse lumps, and dredge the channels. Rehmannia and deer antler gelatin nourish the yin and blood and balance the stimulating action of the other herbs, protecting the kidney yin and restraining the diaphoretic action of ma-huang, yet providing a warming action. Raw licorice is a detoxicant and it also helps to harmonize the yin-nourishing and yang-promoting activities of the other ingredients.

A clinical trial for ovarian cyst treatment involving 26 patients receiving a modified Yang He Tang was carried out by Li Xuejun and Liu Wenxi at the Department of Gynopathy, Linyi Prefectural Hospital of Traditional Chinese Medicine The base formula used was:

rehmannia	(shoudihuang)	20 grams
cinnamon bark	(rougui)	6 grams
ma-huang	(mahuang)	6 grams
sinapis	(baijiezi)	12 grams
persica	(taoren)	10 grams
laminaria	(kunbu)	10 grams
zedoaria	(ezhu)	6 grams

The above herbs were administered in the form of decoction, and 10 grams of deer antler were added to the strained hot liquid, in which it would dissolve. The formula was modified slightly for each patient according to symptom presentation. For example, for lower abdominal pain:

with qi stagnation syndrome, add 12 grams lindera (wuyao)
with blood stagnation syndrome: add 10 grams sparganium (sanleng) and increase the dose of zedoaria (ezhu) to 10 grams
with stabbing pain (a sign of more severe blood stasis): add 10 grams pteropus (wulingzhi) or 10 grams each of myrrh (muyao) and frankincense (ruxiang)
with cold syndrome: add 10 grams aconite (fuzi) and 10 grams artemisia (liujinu)
with pain focused in the waist area (that is, extending around to the back): add 15 grams each of dipsacus (xuduan) and loranthus (sangjisheng)
for yang deficiency syndrome: add 6 grams aconite (fuzi) and 15 grams cistanche (roucongrong)
for yin deficiency syndrome: add 15 grams ligustrum (nuzhenzi) and 20 grams lycium fruit (gouqizi)
for qi deficiency syndrome (which produces a sensation of aching or pain bearing downward): add 20 grams codonopsis (dangshen), 15 grams astragalus (huangqi), and 6 grams cimicifuga (shengma)

Other modifications, for syndromes beside experience of pain, include tonifying the blood when the complexion is poor and the skin appears withered: add 10 grams gelatin (ejiao) and 12 grams each of tang-kuei (danggui) and peony (baishao); when there is damp-heat syndrome (heat may develop after prolonged stagnation): add 12 grams each of prunella (xiakucao) and gentiana (longdancao) and 15 grams coix (yiyiren); or when there is vaginal discharge: increase the dose of laminaria to 15 grams and add 20 grams oyster shell (muli). The complete formula would typically contain 8-10 herbs with a total of about 80-100 grams of herbal materials.

All patients so treated had a cyst on one side. The treatment time for the patients was from 5 to 36 days, and all but three of the patients were cured, according to ultrasound analysis. Two of the other patients had reduced size of the cyst. The remaining uncured patient had surgery and it turned out that the cyst was malignant (teratoma). At the Institute for Traditional Medicine, a formula related to the traditional Yang He Tang, modified with the results of the above study in mind, has been prepared since 1992 in tablet form for easy administration (called Cinnamon and Rehmannia Tablets). The formula includes psoralea (buguzhi) to help warm the kidney yang and polygonatum (huangjing) to protect the kidney and liver from being overheated or dried by the warming tonics. Laminaria and fritillaria (zhebeimu) are used together to resolve the phlegm mass. Zedoaria, persica, and sparganium are included to break up the local stagnated blood and help to quickly restore a normal blood network in the area. The use of blood-vitalizing herbs, such as these last three ingredients, is a relatively new procedure that was developed at the end of the Qing Dynasty period and brought to full use during recent years. Verbal reports from practitioners applying the simple tablet formula over the past four years have been notably favorable. Short treatment time (about one to two months), as indicated by Chinese experience, seems to be adequate, according to their informal observations.

POLYCYSTIC OVARIES

Polycystic ovary syndrome is somewhat different than simple ovarian cyst. It is usually the result of hormonal imbalance (excess of androgen, and with luteinizing hormone elevated). It can be associated with obvious symptoms of menstrual disorder, especially amenorrhea, which is usually caused by the underlying hormone imbalance rather than by the cysts themselves. Furthermore, women suffering from this disorder may display signs of hirsutism and will often be obese.

Despite the differences between polycystic ovaries and simple ovarian cyst from the Western viewpoint, the Chinese medical treatment is often essentially the same: warming up the kidney. The treatment similarity comes about because of the location of the problem and the fact that cysts are involved. Individual symptoms, observable without specific diagnosis of polycystic ovaries, lead to such treatments: amenorrhea is often treated by warming the abdominal organs and promoting blood circulation, while obesity is treated by resolving phlegm accumulation and enhancing metabolism.

The therapeutic principle and accompanying specific formula called “Kidney Reinforcing Regimen” is described in the book Recent Advances in Chinese Herbal Drugs, where it is mentioned as a treatment for polycystic ovarian disease if it is given along with phlegm-resolving herbs. This modern kidney tonic formula is especially helpful in treatment of allergies, which some women with ovarian cysts experience. Specific formula details are provided in the book Modern Clinical Necessities, under the heading of treatment for chronic bronchitis, an unrelated disorder except that kidney yang deficiency and phlegm obstruction also occur. The formula is given as follows:

rehmannia	(shoudihuang and shengdihuang)	12 grams
aconite	(fuzi)	6 grams
dioscorea	(shanyao)	9 grams
epimedium	(yinyanghuo)	9 grams
psoralea	(buguzhi)	9 grams
cuscuta	(tusizi)	9 grams
citrus	(chenpi)	1.5 grams

Aconite, like cinnamon bark, helps restore warmth to the kidney; epimedium, psoralea, and cuscuta further enhance the kidney yang and produce warmth. Citrus is included here primarily to aid the digestion of the rich tonic herbs, mainly the rehmannia. These amounts are for a one day dosage; the herbs are decocted, dried, and made into tablets; the usual instruction is to take 5 tablets each time, three times daily. To treat polycystic ovaries (or bronchitis in which there is substantial phlegm accumulation), this formulation might be combined with a phlegm-resolving formula such as Tan Yin Wan (pill for phlegm accumulation). Tan Yin Wan contains the many of the same ingredients as Cinnamon and Rehmannia Combination, except that ma-huang and deer antler gelatin are replaced by atractylodes (cangzhu and baizhu), aconite, raphanus (laifuzi), and perilla fruit (zisuzi). This pill treats the combined syndrome of deficiency of spleen and kidney yang.

In the book Clinic of Traditional Chinese Medicine (volume 1), there is a short section of polycystic ovaries. There, it is said that there are two basic types from the viewpoint of traditional Chinese medicine. One type is the kidney deficiency syndrome, as described above. The recommended formula is:

rehmannia	(shoudihuang)	12 grams
deer antler gelatin	(lujiaojiao)	9 grams
cuscuta	(tusizi)	12 grams
rubus	(fupenzi)	12 grams
cibotium	(gouji)	9 grams
fenugreek	(hulupa)	9 grams
epimedium	(yinyanghuo)	12 grams
polygonatum	(huangjing)	15 grams
prunella	(xiakucao)	15 grams

Alternatively, it is said that the polycystic ovaries may arise from phlegm-dampness without underlying kidney cold. Such a syndrome usually occurs as the result of liver qi stagnation, which gives rise to other types of stagnation, such as blood stasis and phlegm accumulation. The recommended formula is:

atractylodes	(cangzhu)	9 grams
cyperus	(xiangfuzi)	12 grams
citrus	(chenpi)	9 grams
pinellia	(banxia)	9 grams
laminaria	(kunbu)	12 grams
prunella	(xiakucao)	15 grams
fritillaria	(chuanbeimu)	12 grams
pangolin scale	(chuanshanjia)	12 grams
cremastra	(shancigu)	9 grams
gleditsia	(zaojia)	9 grams
chih-ko	(zhike)	9 grams
hoelen	(fuling)	12 grams

In this formula, cyperus, prunella, citrus, and chih-ko disperse the stagnated qi; citrus, chih-ko and the remaining ingredients remove accumulation of moisture and phlegm. Pangolin scales are included to disperse stagnant blood.

In young women with amenorrhea, physicians at the Long Hua Hospital in Shanghai found that an excess syndrome was often present. That is, there was liver fire in 21 of 28 patients, while only 6 showed the kidney deficiency syndrome and 1 showed the phlegm-dampness syndrome. These physicians prescribed the traditional Gentiana Combination, which contains the following ingredients:

gentiana	(longdan)	6 grams
scute	(haungqin)	9 grams
gardenia	(zhizi)	9 grams
alisma	(zexie)	9 grams
akebia	(mutong)	3 grams
plantago	(cheqianzi)	9 grams
tang-kuei	(danggui)	9 grams
rehmannia	(shengdihuang)	6 grams
bupleurum	(chaihu)	6 grams
licorice	(gancao)	1.5 grams

The amounts of some herbs might be increased, such as using up to 9 grams gentiana, up to 12 grams rehmannia, and up to 3 grams licorice. The formula was given either as decoction or pills. The results of applying this method were mixed. Menstruation resumed in 2/3 of the patients, but it was often irregular; only 8 women had normal menstruation; 9 of the women eventually became pregnant. In the discussion of their work, the authors mention that the methods of tonifying the kidney and resolving phlegm dampness, used by other physicians, had good results. The conclusion one gains is that one should probably be careful to differentiate the syndrome and treat accordingly-not automatically treat with a single method.

According to the general doctrine of Chinese medicine, many diseases develop from an excess condition in the early stage to a deficiency syndrome in the later stage of its development. Thus, young women with polycystic ovaries may tend to have an excess syndrome (as described in the above evaluation, in which the average age of the patients was 24.6 years), and older women may tend to reveal the deficiency syndrome (with kidney yang depleted). However, due to genetic, behavioral, and environmental factors, some young women may already have a deficiency syndrome by the time the particular disease (in this case polycystic ovaries) has developed. Therefore age cannot be used as the sole factor in deciding among treatment strategies.

In a clinical trial by Dr. Yu Jin of the Shanghai Medical University Obstetrics and Gynecology Hospital, 133 patients with polycystic ovary syndrome were treated with the following base formula:

rehmannia	(shoudihuang)	12 grams
dioscorea	(shanyao)	12 grams
polygonatum	(huangjing)	12 grams
epimedium	(yinyanghuo)	12 grams
psoralea	(buguzhi)	12 grams
gleditsia	(zaojiaoci)	12 grams
fritillaria	(chuanbeimu)	12 grams
pangolin scale	(chuanshanjia)	9 grams

This formula was modified either for signs of cold (adding aconite and cinnamon bark) or for liver qi stagnation (adding moutan, gardenia, bupleurum, tang-kuei, and blue citrus, while removing gleditsia and fritillaria). According to Dr. Yu Jin, 82.7% of the women so treated ovulated and of 76 women that were known to be infertile, 36 became pregnant.

In a study carried out by Dr. Ling Zijun at the Jiangxi Province No. 2 People’s Hospital, 27 infertile patients with polycystic ovary syndrome were treated with a group of four consecutive formulas, one each week for a month (stimulating the follicles, inducing ovulation, stimulating the corpus luteum, regulating the menses), with this cycle repeated for as many months as necessary (up to three years in one case) to obtain normal menstruation and fertility. There were four formulas aimed at treating deficiency of kidney yang and an alternative set of four formulas for treating deficiency of kidney yin: both sets contained yang tonics, but for patients with yin deficiency, there were some yang tonic herbs replaced by yin nourishing herbs. According to Dr. Ling, 24 of the 27 women became pregnant.

Women with polycystic ovaries usually show signs of increased testosterone production (hirsutism). It has been shown by several Japanese research teams that this condition may be reversed by using the simple Peony and Licorice Combination, made of equal parts of white peony and licorice. While this formula may not prevent the typical imbalance between FSH and LH (something that could be accomplished, instead, by the kidney reinforcing regimen), it does affect the conversion of androsterones to testosterone and therefore may have immediate beneficial effects by reducing testosterone levels.

OVARIAN CYSTADENOMA

From the Chinese perspective, cancerous ovarian cyst differs from the simple ovarian cyst in that it is complicated by significant blood stasis, which then develops into a polluted syndrome, and finally into a significant deficiency syndrome. According to Dr. Pan Mingji, in his book Treating Cancer with Fu Zheng Pei Ben Principle, the prognosis for this type of cancer depends on many factors, but it has generally poor outcome, with a five year survival rate of 30%. The prognosis is better for those who begin treatment in the early stage, while the tumor cells remain well-differentiated, and while there is strong body resistance. He reports that traditional Chinese medicine used alone does not usually produce satisfactory results, but the combination of traditional Chinese medicine and Western medicine applied to early stage ovarian cancer yields an especially good prognosis. He presents several sample formulas for use along with Western medicine. For the early stage of the disease, he recommends the following prescription:

eupolyphaga	(zhechong)	12 grams
sparganium	(sanleng)	12 grams
tang-kuei	(danggui)	9 grams
red peony	(chishao)	10 grams
hoelen	(fuling)	12 grams
licorice	(gancao)	3 grams
codonopsis	(dangshen)	10 grams
dioscorea	(shanyao)	10 grams
astragalus	(huangqi)	12 grams
bupleurum	(chaihu)	12 grams
salvia	(danshen)	8 grams
cremastra	(shancigu)	12 grams
atractylodes	(baizhu)	10 grams

For the most part, this formula promotes the blood circulation; it includes herbs to increase the qi and improve qi circulation, both in support of enhancing the blood circulation. Dr. Pan suggests that treatment with herbs (and, as may be appropriate chemotherapy) should be undertaken before surgery, so that the tumor mass may be shrunken. This approach of delaying surgery may not be deemed acceptable in the West.